Low Testosterone Specialists – Miami Urologists

“Low testosterone and male andropause has become a hot topic over the past decade.  Aging men with symptoms of low sex drive, decreased energy and muscle mass as well as erectile dysfunction are seeking a remedy for their complaints.  These symptoms may be secondary to low testosterone.  In addition to the symptoms of decreased energy and libido associated with low testosterone, patients may also be at risk for osteoporosis, decreased muscle mass, impaired cognitive ability and concentration, decreased exercise tolerance and even metabolic syndrome and impaired heart health.  If you are experiencing any of the above symptoms, please contact us or your current urologist to have your testosterone levels evaluated.  Miami urologists David Robbins, MD and Amery Wirtshafter, MD are board certified urologist specializing in the evaluation and treatment of male hypogonadism or testosterone deficiency. 
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Filed under: Men’s Health

(MayoClinic.com) Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, however, sex hormone changes in men occur gradually — over a period of many years. Here’s what to expect, and what you can do about it.

Debunking the male menopause myth

The term “male menopause” is sometimes used to describe decreasing testosterone levels or a reduction in the bioavailability of testosterone related to aging. Female menopause and so-called male menopause are two different situations, however. In women, ovulation ends and hormone production plummets during a relatively short period of time. In men, hormone production and testosterone bioavailability decline more gradually. The effects — such as changes in sexual function, energy level or mood — tend to be subtle and might go unnoticed for years.

So what’s the best way to refer to so-called male menopause? Many doctors use the term “andropause” to describe aging-related hormone changes in men. Other terms for so-called male menopause include testosterone deficiency, androgen deficiency of the aging male and late-onset hypogonadism.

Understanding male hormones over time

Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. By about age 70, the decrease in a man’s testosterone level can be as much as 50 percent.

Recognizing low testosterone levels

Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:

  • Changes in sexual function.This might include erectile dysfunction, reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility. Your testes might become smaller as well.
  • Changes in sleep patterns.Sometimes low testosterone causes sleep disturbances, such as insomnia, or increased sleepiness.
  • Physical changes.Various physical changes are possible, including increased body fat; reduced muscle bulk, strength and endurance; and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Rarely, you might experience hot flashes and have less energy.
  • Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things.

It’s important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.

Feeling your best

If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can’t boost your natural testosterone production, but these steps might help:

  • Be honest with your doctor.Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms — from medication side effects to erectile dysfunction and other sexual issues.
  • Make healthy lifestyle choices.Eat a healthy diet and include physical activity in your daily routine. Healthy lifestyle choices will help you maintain your strength, energy and lean muscle mass. Regular physical activity can even improve your mood and promote better sleep.
  • Seek help if you feel down.Depression in men doesn’t always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.
  • Be wary of herbal supplements. Herbal supplements haven’t been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.

Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however — particularly older men — the benefits aren’t clear. The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Radical Prostatectomy Surgery Miami

“Nerve Sparing Radical Prostatectomy in addition to providing the benefit of improved post operative erectile function for men with localized prostate cancer may improve the ability to achieve normal orgasm.   Miami urologist, David Robbins, MD is a regional expert in robotic assisted radical prostatectomy using the da Vinci surgical robot and offers patients the opportunity to have their prostate cancer treated with minimal effect on their quality of life with regard to measures such as erectile function and maintenance of continence.  This article shows evidence that nerve sparing prostatectomy may additionally result in improved ability to achieve normal orgasms.”  Miami urologist, David Robbins MD

Nerve-Sparing Prostate Surgery Helps Men Retain Sexual Function

Most men left with nerves on both sides of the gland can achieve orgasm, study shows

THURSDAY, Feb. 16 (HealthDay News) — Most men who have surgery for prostate cancer can still achieve orgasm if the nerves that surround their prostate gland are not removed, according to a new study.

Researchers from Cornell University say a man’s age and the number of his nerves that are spared will play a role in his ability to climax after surgery.

The study followed 408 men who underwent a procedure to remove their prostate, known as robot-assisted laparoscopic radical prostatectomy, between 2005 and 2007 for an average of three years. Men had mean age of 60 years and all were able to have an orgasm before the procedure.

Seventy-four percent of the men were able to have their nerves spared bilaterally, or on both sides. Of those men, 91 percent experienced no change in their ability to achieve orgasm following the surgery.

About 13 percent of the men had their nerves spared on only one side. Of this group, 82 percent of the men had the same ability to reach orgasm. Another 12 percent had little or no nerve sparing, with 62 percent of them were still able to achieve orgasm the same way they did before the operation.

The men’s age also played a role in their ability to orgasm. The study, published in the February issue of BJUI, showed orgasm rates were significantly higher in men younger than 60 who had their nerves spared on both sides. Orgasm rates dropped by 10 percent to 83 percent among men older than 60, even if their nerves were spared on both sides.

A questionnaire completed by 156 of the men who were able to achieve orgasm after surgery revealed 82 percent had high satisfaction rates. Another 10 percent said they had moderate satisfaction and 7 percent reported low satisfaction. Roughly 3 percent of the men said they experienced a painful orgasm.

“As far as we are aware, this is the largest analysis of orgasmic function in the robotic prostatectomy literature and will provide valuable information for surgeons talking to patients about what sort of sexual function they can expect after surgery,” study author Dr. Ashutosh Tewari, director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at Weill Cornell Medical College, said in a journal news release.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

— Mary Elizabeth Dallas

SOURCE: Wiley-Blackwell, news release, Feb. 13, 2012

Last Updated: Feb. 16, 2012

Copyright © 2012 HealthDay. All rights reserved.

Best Robotic Prostate Cancer Surgeon Miami

David Robbins, MD is a board certified urologist in Miami and well known expert in the field of robotic prostate cancer surgery.  Dr. Robbins is currently performing robotic prostate cancer surgery out of Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.  Miami urologist Dr. David Robbins received specialized training in robotic prostatectomy from experts in the field during his training at NYU Medical Center in New York.   He has an excellent track record with regard to prostate cancer cure, preservation of erectile function and maintenance of urinary continence.

Prostate Cancer Surgery Miami

“This is another article which highlights the debate over PSA screening for prostate cancer.  It seems that although the US Preventative Task Force has decided unilaterally to recommend against PSA screening, government officials including President Obama and Senator Wyden have chosen to ignore the recommendations and have their PSA screened.  Senator Wyden additionally underwent surgery after being diagnosed with prostate cancer.”  David Robbins

The politics of prostate cancer

  • Sen. Ron Wyden walks to the Senate floor on Capitol Hill. | AP Photo
Sen. Ron Wyden chose surgery for prostate cancer over ‘active surveillance.’ | AP PhotoClose
By DIANE WEBBER | 12/21/10 4:40 AM EST

Sen. Ron Wyden had surgery for prostate cancer Monday, putting himself — through no fault of his own — in the middle of a debate about diagnosis, treatment and bending the cost curve.

The longtime health care advocate and Oregon Democrat was operated on by Alan Partin at Johns Hopkins Hospital in Baltimore. The cancer was caught early, and Wyden, 61, has an excellent prognosis, according to his office.

The option known as “active surveillance” (formerly “watchful waiting”) allows patients to avoid or delay surgery, radiation and chemotherapy — and the side effects that come with those treatments. Active surveillance means coming back to the doctor on a regular schedule for a blood test and examination to see if the cancer is growing. But few men choose it.

Wargo discusses active surveillance with her patients, and she considers it a good option for those who fear surgery or have other serious health problems. She is on board with the new nomenclature. “Watchful waiting sounds like you can just go disappear and not come back to see me,” she said. But she understands why many men choose surgery. “There is a personality of men who can’t live with the idea that there is something inside them that could kill them.”

Bruce Quinn, M.D., health specialist with Foley Hoag and a former official in California’s Medicare program, pointed out that, over a five-year period, active surveillance doesn’t save significant funds, because the slow-growing cancers often become aggressive and require more expensive, invasive treatment.

“It’s not the difference of $100 versus $30,000 if you look at the cost comparisons over five years. Active surveillance is more costly than people think,” said Quinn. “It’s not popular, I think, because patients must find it pretty uncomfortable to be told they have a 2-to-3-centimeter tumor that could eventually blow up and kill them, and we’re just going to watch it. Men say, ‘Just get the damn thing out!’”

Wargo and Quinn both noted problems with the prostate-specific antigen test that is the screening tool used for diagnosis. A normal level in one individual might be abnormal in another, and doctors need to track changes in the level over time to approach any kind of accuracy.

“You really have to look at each patient individually,” said Wargo. “A PSA level of 4 is normal in an older patient, but it is completely unacceptable in a 47-year-old. You can have a low level and still have aggressive prostate cancer.”

Complicating matters is the fact that no test accurately predicts who will get the aggressive, deadly form of the disease and who will get a slow-growing, non-life-threatening form. Quinn points to Medicare reimbursements as part of the problem.

In choosing surgery over what used to be called “watchful waiting,” Wyden took a path that many men take when faced with a prostate cancer diagnosis. But increasingly, that path is questioned in the era of health care reform, as cost-cutting is pitted against personal choice.

Doctors acknowledge that the cost-cutters have a point but bristle at the intrusion into the physician-patient relationship.

“It is well and good for statisticians to say, ‘This is the patient who doesn’t need to be treated,’” said Heather C. Wargo, a urologist practicing in Mount Laurel, N.J. “But when I am sitting with a patient, looking him and his spouse in the eye, it is very difficult to say, ‘I’ve been accused of overtreating, so I’m not going to treat you.’”

The U.S. Preventive Services Task Force, the body that sparked a firestorm when it said that most women do not need an annual mammogram until age 50, was set to vote on new prostate-cancer-screening recommendations last month. Instead, the panel canceled its November meeting, citing “scheduling conflicts.”

Kenneth Lin, professor and family physician, quit the task force in protest. “Politics trumped science this time, as it has in the past, and may at times in the future,” Lin wrote in his blog, where he linked to a news account of the mammogram controversy.

Rep. Debbie Wasserman Schultz (D-Fla.), who had breast cancer, told POLITICO that the task force “seems out of touch with reality.”

“I think that organization really undermines its credibility, not necessarily among the scientific community but for the general public,” Wasserman Schultz said, noting that there were no cancer experts on the panel when the breast-cancer-screening recommendations were made.

Yet statistical analysis like the task force’s research has some of the greatest potential to save money on health care spending.

Prostate cancer is ripe for study. Researchers question whether it is being overdiagnosed and whether too many surgeries are being performed on tumors that would never become dangerous.

“The Medicare fee schedule is around $20 for the PSA test, and it is just frozen there,” said Quinn. “It’s really hard for companies to do the trials that they need to do to come up with a more effective, more precise prostate cancer test with this artificially very low fee.”

Mara Aspinall is CEO of On-Q-ity, a company working on new diagnostic tests that have the potential to identify rare cancer cells circulating in the bloodstream, long before they are prevalent enough to be picked up as tumors on MRI and CT scans.

Aspinall said the Medicare fee schedule is a problem for her new technology. “In the laboratory, the more steps your process has, the more you’re paid,” she said. “This was a useful construct some time ago, but it has not kept pace with technology. We now can have one really big step to replace 10 small ones. It’s an incredible disincentive.”

While Aspinall argued that better diagnostic tests could bring more clarity and potential cost savings to prostate cancer treatment, she emphasized that tests can’t replace the doctor-patient dialogue.

“It is essential that the decision on how to proceed — even in the era of diagnostics — needs to continue to be an educated discussion between the physician and the patient,” said Aspinall. “We want to bring more information to the equation.”

Wyden will no doubt be helpful in bringing more information to the equation as he recovers from his disease. He started working on public health issues as a young lawyer when he founded a legal aid society for the elderly and Oregon’s first chapter of the Gray Panthers. During health care reform, he was the architect of the Healthy Americans Act, which would have radically changed health care from the employer-based system, and now he is co-sponsoring a bill that encourages states to innovate on reform implementation.

“If anything is taken away from my experience, I hope it is the importance of getting routine physicals,” Wyden said as he was disclosing his disease last week. “One in six men will be diagnosed with prostate cancer during their lifetimes. Early detection is critical to catching this disease when treatment is most effective.”

Welcome to Urological Consultants of Florida

Urological Consultants of Florida has been recognized as a preeminent provider of urology and urological services to patients in the greater Miami region and around the world for more than thirty years. At Urological Consultants of Florida, our core mission is to provide compassionate, quality urological and urology care using the most innovative, minimally invasive techniques available to successfully address our patients’ needs.

Our board certified urologists Amery Wirtshafter, MD and David Robbins, MD are recognized leaders in the field of urology in Miami, South Florida and the surrounding region.  Our Miami urologists specialize in all aspects of urology with specific focus in the treatment of prostate cancer, kidney cancer, BPH, kidney stones, bladder cancer, urinary incontinence, erectile dysfunction, urinary tract infections and more.  We have two convenient offices located at Mount Sinai Medical Center in Miami Beach and Miami Gardens Drive in North Miami Beach.


For your convenience, Urological Consultants of Florida offers two convenient locations, one in Miami Beach and another in North Miami Beach.  Our full service urology specialists are available for urological consultation five days a week in both offices and are available for emergencies at all hours seven days a week.

Miami Beach Office

Miami Beach Office

4302 Alton Road
Suite 920
Miami Beach, FL 33140

Phone: (305) 672-4222
Fax: (305) 672-5461

Office Hours

9:00 am – 5:00 pm


North Miami Beach Office

North Miami Beach Office

1400 N.E. Miami Gardens Drive
Suite 209
North Miami Beach, FL 33179

Phone: (305) 944-0025
Fax: (305) 944-3624

Office Hours

9:00 am – 5:00 pm